Gaming Technology and Cardiac Rehabilitation

NCT ID: NCT05149235

Last Updated: 2025-08-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

86 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-03-10

Study Completion Date

2024-08-30

Brief Summary

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Moderate to vigorous physical activity has been shown to be associated with autonomic regulation of the heart measured with heart rate variability. Cardiac autonomic modulation can be evaluated by heart rate variability. Activity promoting games can be an effective tool to aid rehabilitation in clinical settings. Combining gaming with the ergo-cycle can facilitate improving patients' activity time spent on the cycle.

Detailed Description

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Physical activity is recognized as a central component of cardiac rehabilitation, improving control of cardiovascular risk factors, reducing the incidence of adverse events, leading to improvements in cardiovascular conditioning and prevention of thromboembolic events. Consequently, it provides greater physical independence and safety for hospital discharge. Coronary artery bypass grafting (CABG) surgery may lead to prolonged bed rest, and immobility, which can result in negative consequences, such as a decrease in functional capacity, decrease in muscle mass and muscle tone, postural hypotension, and changes in autonomic modulation of the heart rate. Cardiac autonomic modulation can be evaluated by heart rate variability (HRV), which involves simple noninvasive measurement of the oscillations in intervals between consecutive heartbeats.

Technology such as video games plays a complicated role in physical inactivity-much like a double-edged sword. To overcome this problem, the newly emerged active video games have been increasingly used to promote physical activity and health among various populations. Augmented reality games are unique because they integrate the physical and virtual worlds into a single interface using mobile devices applications. Investigators present a proof of concept of an endless running game called physio adventure which implements an activity recognition system that detects cycle rotation and its speed. The goal is to replace the traditional rehabilitation devices with innovative gaming technology with a more natural movement-based one, showing the potential of this kind of interaction to create innovative and immersive experiences while promoting physical activity.

Conditions

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Open Heart Surgery

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

Study Groups

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early mobilization group

this group will perform early mobilization exercises using a cycle ergometer.

Group Type ACTIVE_COMPARATOR

early mobilization group

Intervention Type OTHER

Participants will perform exercises using only the cycle ergometer and ambulation. In this group, participants will be instructed to turn the pedals continuously, without any weight added to the equipment (only on 1st post-operative day) and training load will be determined by a fatigue level maintenance of 4 or 5 on the modified Borg scale with a maximum HR elevation of 20% on 2nd and 3rd post-operative days. Duration of exercise will be of 10 minutes (five minutes with the upper limbs and five minutes with the lower limbs). For the arm exercises, the individuals will be positioned with the head end of the bed raised to 60° above the horizontal, while ensuring that all the equipment responsible for measuring the patient's vital signs remained connected. For the leg exercises, the head end of the bed will be lowered to a 30° angle to provide better access to the pedals and avoid compensatory hip movements. Ambulation will be performed only on 3rd post-operative day (40 meters).

game tech group

this group will use physio adventure device instead of a cycle ergometer

Group Type EXPERIMENTAL

physio adventure

Intervention Type DEVICE

The protocol applied to the experimental group will be the same of that applied to the early mobilization group with the use of smart move instead of cycle ergometer.

placebo group

this group is placebo control and will receive routine respiratory physiotherapy

Group Type PLACEBO_COMPARATOR

placebo

Intervention Type OTHER

Participants allocated to the Control group will perform respiratory physiotherapy (Flow-oriented incentive spirometer (3×15), active exercises for lower and upper limbs, with each movement being repeated 10 times in an open kinetic chain. For the upper limbs, movements of anterior flexion of the shoulder will be performed until achieving maximum range of motion, using diagonal movements starting at the contralateral iliac crest up to the maximum range of anterior flexion of the shoulder associated with supination. For the lower limbs, exercises will consist of straight leg raises, hip and knee flexion-extension exercise and ankle pumps. Sessions will be of 10 minutes duration.

Interventions

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early mobilization group

Participants will perform exercises using only the cycle ergometer and ambulation. In this group, participants will be instructed to turn the pedals continuously, without any weight added to the equipment (only on 1st post-operative day) and training load will be determined by a fatigue level maintenance of 4 or 5 on the modified Borg scale with a maximum HR elevation of 20% on 2nd and 3rd post-operative days. Duration of exercise will be of 10 minutes (five minutes with the upper limbs and five minutes with the lower limbs). For the arm exercises, the individuals will be positioned with the head end of the bed raised to 60° above the horizontal, while ensuring that all the equipment responsible for measuring the patient's vital signs remained connected. For the leg exercises, the head end of the bed will be lowered to a 30° angle to provide better access to the pedals and avoid compensatory hip movements. Ambulation will be performed only on 3rd post-operative day (40 meters).

Intervention Type OTHER

physio adventure

The protocol applied to the experimental group will be the same of that applied to the early mobilization group with the use of smart move instead of cycle ergometer.

Intervention Type DEVICE

placebo

Participants allocated to the Control group will perform respiratory physiotherapy (Flow-oriented incentive spirometer (3×15), active exercises for lower and upper limbs, with each movement being repeated 10 times in an open kinetic chain. For the upper limbs, movements of anterior flexion of the shoulder will be performed until achieving maximum range of motion, using diagonal movements starting at the contralateral iliac crest up to the maximum range of anterior flexion of the shoulder associated with supination. For the lower limbs, exercises will consist of straight leg raises, hip and knee flexion-extension exercise and ankle pumps. Sessions will be of 10 minutes duration.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Patients submitted to elective cardiac surgery (valvular or coronary bypass surgery by sternotomy)
* Both male and female
* a score of 15 on the Glasgow Coma Scale
* musculoskeletal, and cardiopulmonary conditions suitable for the accomplishment of the proposed activities
* absence of neurological sequelae and/or neurodegenerative diseases

Exclusion Criteria

* Those who had difficulty understanding the activities involved in the study.
* those with any motor or neurological impairment that would prevent them from using a cycle ergometer.
* those who discontinued the protocol on the ward for return to the ICU
* previous cardiac surgeries
* hemodynamic instability that prevented protocol performance
* breathing discomfort
* invasive ventilatory support
* oxygen saturation below 90% (even with complementary oxygen therapy)
* coagulation disorders
* infections in any of the systems
* nonperformance of the whole protocol
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Bahria University

OTHER

Sponsor Role lead

Responsible Party

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Seyyada Tahniat Ali

clinical instructor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Seyyada T Ali

Role: PRINCIPAL_INVESTIGATOR

bahria university medical and dental college

muhammad i tariq

Role: STUDY_DIRECTOR

Riphah International University

urooj fatima

Role: STUDY_CHAIR

bahria university medical and dental college

Locations

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Seyyada Tahniat Ali

Karachi, Sindh, Pakistan

Site Status

Countries

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Pakistan

References

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European Association of Cardiovascular Prevention and Rehabilitation Committee for Science Guidelines; EACPR; Corra U, Piepoli MF, Carre F, Heuschmann P, Hoffmann U, Verschuren M, Halcox J; Document Reviewers; Giannuzzi P, Saner H, Wood D, Piepoli MF, Corra U, Benzer W, Bjarnason-Wehrens B, Dendale P, Gaita D, McGee H, Mendes M, Niebauer J, Zwisler AD, Schmid JP. Secondary prevention through cardiac rehabilitation: physical activity counselling and exercise training: key components of the position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur Heart J. 2010 Aug;31(16):1967-74. doi: 10.1093/eurheartj/ehq236. Epub 2010 Jul 19.

Reference Type BACKGROUND
PMID: 20643803 (View on PubMed)

Gama Lordello GG, Goncalves Gama GG, Lago Rosier G, Viana PADC, Correia LC, Fonteles Ritt LE. Effects of cycle ergometer use in early mobilization following cardiac surgery: a randomized controlled trial. Clin Rehabil. 2020 Apr;34(4):450-459. doi: 10.1177/0269215520901763. Epub 2020 Jan 29.

Reference Type BACKGROUND
PMID: 31994405 (View on PubMed)

Cacau Lde A, Oliveira GU, Maynard LG, Araujo Filho AA, Silva WM Jr, Cerqueria Neto ML, Antoniolli AR, Santana-Filho VJ. The use of the virtual reality as intervention tool in the postoperative of cardiac surgery. Rev Bras Cir Cardiovasc. 2013 Jun;28(2):281-9. doi: 10.5935/1678-9741.20130039.

Reference Type BACKGROUND
PMID: 23939326 (View on PubMed)

Kulur AB, Haleagrahara N, Adhikary P, Jeganathan PS. Effect of diaphragmatic breathing on heart rate variability in ischemic heart disease with diabetes. Arq Bras Cardiol. 2009 Jun;92(6):423-9, 440-7, 457-63. doi: 10.1590/s0066-782x2009000600008. English, Multiple languages.

Reference Type BACKGROUND
PMID: 19629309 (View on PubMed)

Karapolat H, Engin C, Eroglu M, Yagdi T, Zoghi M, Nalbantgil S, Durmaz B, Kirazli Y, Ozbaran M. Efficacy of the cardiac rehabilitation program in patients with end-stage heart failure, heart transplant patients, and left ventricular assist device recipients. Transplant Proc. 2013 Nov;45(9):3381-5. doi: 10.1016/j.transproceed.2013.06.009.

Reference Type BACKGROUND
PMID: 24182820 (View on PubMed)

Oliveira NL, Ribeiro F, Alves AJ, Teixeira M, Miranda F, Oliveira J. Heart rate variability in myocardial infarction patients: effects of exercise training. Rev Port Cardiol. 2013 Sep;32(9):687-700. doi: 10.1016/j.repc.2013.02.010. Epub 2013 Aug 30.

Reference Type BACKGROUND
PMID: 23993292 (View on PubMed)

Gao Z. Fight fire with fire? Promoting physical activity and health through active video games. J Sport Health Sci. 2017 Mar;6(1):1-3. doi: 10.1016/j.jshs.2016.11.009. Epub 2016 Nov 24. No abstract available.

Reference Type BACKGROUND
PMID: 30356540 (View on PubMed)

Baranowski T. Pokemon Go, go, go, gone? Games Health J. 2016 Oct;5(5):293-294. doi: 10.1089/g4h.2016.01055.tbp. Epub 2016 Aug 15. No abstract available.

Reference Type BACKGROUND
PMID: 27525347 (View on PubMed)

Pasco D, Roure C, Kermarrec G, Pope Z, Gao Z. The effects of a bike active video game on players' physical activity and motivation. J Sport Health Sci. 2017 Mar;6(1):25-32. doi: 10.1016/j.jshs.2016.11.007. Epub 2016 Nov 24.

Reference Type BACKGROUND
PMID: 30356595 (View on PubMed)

Ribeiro BC, Poca JJGD, Rocha AMC, Cunha CNSD, Cunha KDC, Falcao LFM, Torres DDC, Rocha LSO, Rocha RSB. Different physiotherapy protocols after coronary artery bypass graft surgery: A randomized controlled trial. Physiother Res Int. 2021 Jan;26(1):e1882. doi: 10.1002/pri.1882. Epub 2020 Oct 25.

Reference Type BACKGROUND
PMID: 33103326 (View on PubMed)

Other Identifiers

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FRC-BUMDC 23/2021

Identifier Type: -

Identifier Source: org_study_id

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